Healthcare Provider Details

I. General information

NPI: 1033797949
Provider Name (Legal Business Name): LUIS ALBERTO CABRERA LOPEZ
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/31/2021
Last Update Date: 07/24/2026
Certification Date: 07/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 NW BRONCO TER
LAKE CITY FL
32055-1148
US

IV. Provider business mailing address

675 NW BRONCO TER
LAKE CITY FL
32055-1148
US

V. Phone/Fax

Practice location:
  • Phone: 305-747-3146
  • Fax:
Mailing address:
  • Phone: 305-747-3146
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSZ13399
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-20-118088
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: